Presentation on theme: "Tufts Health Unify Behavioral Health Model of Care & Member Experience"— Presentation transcript:
1 Tufts Health Unify Behavioral Health Model of Care & Member Experience Kathleen I. Connolly, PMPVice President, Sales, Marketing, and Products Executive Director, UnifyRonald A. Seletsky, M.Ed., L.S.W., L.M.H.C.Manager, Behavioral Health, Social Care Management,and Community Health TeamNovember 21, 2014
2 Tufts Health Unify Behavioral Health Model of Care MemberEmergency ServicesProgramTufts Health Plan-Network Health care managerOther Member SupportsPartial Hospitalization ProgramAcute treatment Services(detox)EnhancedAcute Treatment ServicesPsychiatric Day TreatmentIntensive Outpatient ProgramsCommunity Crisis Stabilization ServicesDual Diagnosis Acute Residential TreatmentCommunity Support ProgramPrimary careprovider (PCP)Interdisciplinarycare teamGroup CounselingStructured Outpatient Addiction ProgramCommunity SupportServicesSpecialists & Other Ancillary ProvidersIn-hometherapyClubhousePeer Support
3 More than Half (56%) of Tufts Health Unify members have at least one behavioral health need in addition to physical needsUnify BH Care Managers co-manage members with Medical Care Managers & Community Health Workers to address member needs
4 Supporting Member Transitions of Care Tufts Health Unify members receive support as they transition between community-based care services and inpatient hospital admissions. Members also receive support as they transition back to their primary residence.As BH members are discharged from the hospital, the member’s Care Manager works collaboratively with the hospital discharge team and member to ensure supports are in place. These include:Follow-up appointments scheduled with their PCP, other medical providers, and behavioral health providers as appropriateAccess to medicationsAccess to long term supports and services (LTSS)Access to community resourcesOngoing follow-up by the Unify Care Manager
5 Enhancing Member Engagement Tufts Health Unify care managers utilize motivational interviewing to enhance member engagement in meeting their health and wellness goals.Motivational interviewing is a treatment technique that seeks to increase internal motivation through an increase in self-efficacy.Member-centric: care managers meet the member where they are. The member’s perspective of the problem is essential.Evidence-based: proven effective in members with medical and substance use issuesDirective: care managers facilitate member in the direction of making a positive change and to explore the possibility of health and change based on Stages of Change.Collaborative: care manager works with member towards a common goal, and provides options, not answers, for the member.
6 Improvement Opportunities Better contact information at time of enrollmentAdditional LTS CoordinatorsIncreasing member trust of care management systemOur members have a significant profile of chronic medical, behavioral health, financial and social needs; there are always opportunities for improvement in efforts to coordinate care